盐酸贝那普利对冠状动脉粥样硬化性心脏病合并高血压患者冠状动脉介入治疗后对比剂肾病的影响

Role of Benazepril on Contrast Induced Nephropathy in Patients of Coronary Heart Disease with Hypertension Undergoing Coronary Angioplasty

背景有研究结果表明血管紧张素转换酶抑制剂(ACEI)能减轻对比剂对肾脏的损伤,但也有研究表明应用ACEI类药物是对比剂肾病(CIN)的危险因素。目的观察盐酸贝那普利对冠状动脉粥样硬化性心脏病(冠心病)合并高血压患者行冠状动脉介入治疗后肾功能的影响。方法连续入选119例冠心病合并高血压并接受冠状动脉介入治疗的患者。按照完全随机化原则分为使用盐酸贝那普利组和对照组(未用盐酸贝那普利)。盐酸贝那普利组在冠状动脉造影前至少3d应用盐酸贝那普利10mg,1次/d,术后继续使用至少3d。记录患者的基本资料及术后72h血清肌酐并用MDRD方法计算其术前、术后估计肾小球滤过率(eGFR)。分析介入治疗后CIN的发生率,两组冠状动脉介入术前后eGFR、血清肌酐的变化。结果盐酸贝那普利组手术前后eGFR、血清肌酐未有显著性差异。而对照组术后eGFR较术前明显降低(P=0.002),术后血清肌酐较术前明显增加(P=0.003)。术后72h血清肌酐与基线血清肌酐的差值(ΔScr)对照组明显升高(P=0.020),ΔeGFR明显降低(P=0.012)。盐酸贝那普利组CIN发生率较对照组有下降趋势(4.92%比8.62%,P>0.05)。结论对高血压合并冠心病患者行冠状动脉介入治疗,术前应用盐酸贝那普利是安全的,并可能有保护肾功能,预防对比剂肾病的作用。

Backgroud Some reports have suggested the use of angiotensin converting enzyme inhibitor （ACEI） for protecting the kidneys from contrast-induced nephropathy （CIN）.Other reports have implicated that ACEI is nephrotoxic and can exacerbate renal failure due to CIN.Objective To study the role of benazepril on CIN in patients of coronary atherosclerotic heart disease （CHD） with hypertension undergoing coronary angioplasty.Methods One hundred ninteen hospitalized patients of CHD with hypertension undergoing coronary angioplasty were enrolled to the study.Patients were randomly divided to benazepril group （n=61） or control group （n=58）.In the benazepril group,the patients received benazepril tablets 10 mg qd at least for 3 days before procedure and continued to use benazepril at least 3 days after procedure.The baseline clinical,biochemical,and procedural characteristics were collected prospectively before the angioplasty,and follow-up serum creatinine were measured 72 h after angioplasty.Baseline and follow-up glomerular filtration rate （eGFR） were estimated using the Modified Diet in Renal Disease study （MDRD） formula.We analyzed and compared the incidence of CIN after angioplasty,the change of serum creatinine,and eGFR between the two groups.Results There were no significant differences at baseline in majority measured parameters between two groups.Serum creatinine,eGFR after angioplasty were unchanging compared to pre-procedure in the benazepril group.eGFR level decreased from （88.7±20.9） to （84.3±19.5）mL/min in control group （P=0.002）;Scr level increased from （73.7±17.5） to （77.2±19.3）μmol/L （P=0.003）.In the control group,the post-procedure Scr（Scr） increased significantly from baseline （P=0.020）,eGFR decreased significantly（P=0.012）.The incidence rate of CIN in benazepril group was slightly lower than that in control group （4.92% vs 8.62%,P0.05）.Conclusion Using benazepril to treat patients of CHD with hypertension before coronary angioplasty is safe,and has potential protective effect on the renal function.